The relationship of individual comorbid chronic conditions to diabetes care quality.

ObjectiveMultimorbidity affects 26 million persons with diabetes, and care for comorbid chronic conditions may impact diabetes care quality. The aim of this study was to determine which chronic conditions were related to lack of achievement or achievement of diabetes care quality goals to determine potential targets for future interventions.Research design and methodsThis is an exploratory retrospective analysis of electronic health record data for 23 430 adults, aged 18-75, with diabetes who were seen at seven Midwestern US health systems. The main outcome measures were achievement of six diabetes quality metrics in the reporting year, 2011 (glycated haemoglobin (HbA1c) control and testing, low-density lipoprotein control and testing, blood pressure control, kidney testing). Explanatory variables were 62 chronic condition indicators. Analyses were adjusted for baseline patient sociodemographic and healthcare utilization factors.ResultsThe 62 chronic conditions varied in their relationships to diabetes care goal achievement for specific care goals. Congestive heart failure was related to lack of achievement of cholesterol management goals. Obesity was related to lack of HbA1c and BP control. Mental health conditions were related to both lack of achievement and achievement of different care goals. Three conditions were related to lack of cholesterol testing, including congestive heart failure and substance-use disorders. Of 17 conditions related to achieving control goals, 16 were related to achieving HbA1c control. One-half of the comorbid conditions did not predict diabetes care quality.ConclusionsFuture interventions could target patients at risk for not achieving diabetes care for specific care goals based on their individual comorbidities

Surface composition of BaTiO3/SrTiO3(001) films grown by atomic oxygen plasma assisted molecular beam epitaxy

We have investigated the growth of BaTiO3 thin films deposited on pure and 1% Nb-doped SrTiO3(001) single crystals using atomic oxygen assisted molecular beam epitaxy (AO-MBE) and dedicated Ba and Ti Knudsen cells. Thicknesses up to 30 nm were investigated for various layer compositions. We demonstrate 2D growth and epitaxial single crystalline BaTiO3 layers up to 10 nm before additional 3D features appear; lattice parameter relaxation occurs during the first few nanometers and is completed at {\guillemotright}10 nm. The presence of a Ba oxide rich top layer that probably favors 2D growth is evidenced for well crystallized layers. We show that the Ba oxide rich top layer can be removed by chemical etching. The present work stresses the importance of stoichiometry and surface composition of BaTiO3 layers, especially in view of their integration in devices.Comment: In press in J. Appl. Phy

The use of ALD and PVD coatings as defect sealants to increase the corrosion resistance of thermal spray coatings

Thermal spray coatings are widely used to improve the surface properties of materials, in particular the wear and oxidation resistance. Nevertheless, the corrosion resistance is slightly increased due to the fact that this type of coatings present some internal defects (pores, cracks) that allow the corrosive media to penetrate up to the substrate, that undergoes to corrosion degradation. The amount of these defects is strongly influenced by both the deposition technique and the material deposited. The aim of this work is to seal the internal porosities of the thermal spray coatings by the use of both PVD and ALD coatings or the combination of the two. The thermal spray coating analysed in this work is a pure alumina coating, deposited by Air Plasma Spray (APS) technique, that has been sealed with CrN coating, deposited by PVD (Physical Vapour Deposition) technique, and/or TiO2 coatings, deposited by ALD (Atomic Layer Deposition). The substrate used is a common medium C steel. The samples were then characterized in order to determine the microstructure (SEM+EDXS, light microscope) and the chemical composition (Rf-GDOES elemental profiling), that is important to determine the depth of penetration of the PVD and/or ALD coating inside the thermal spray deposit. Afterwards, a detailed electrochemical characterization in 3,5wt% NaCl aqueous solution was performed to verify the efficiency of the sealant treatment. In detail, a monitor in function of the time of the OCP potential was performed up to 24h of immersion time. In addition, potentiodynamic tests were performed using a 3 electrode electrochemical cell (CE: Pt wire, RE: Ag/AgCl). The same tests were then performed on the same samples that present an artificial defect produced by Rf-GDOES. The main goal of these tests is to determine the maximum depth of a defect that can allow the corrosive media to penetrate the thermal spray coating. Preliminary results showed that the use of PVD and ALD coatings as sealants can reduce the permeation of the corrosive media on the substrate

Synthesis, crystallographic characterization, and mechanical behavior of alumina chromia alloys

Powder mixtures of Alumina and Chromia, blended in different proportions (1, 3, 5 and 10%wt) by attrition milling, were fired either by pressureless sintering in air and hot pressing under vacuum. The resulting materials, characterized by X-ray diffraction, Raman spectroscopy, SEM, hardness and fracture toughness showed that all the compositions form complete solid solution which maintain the same crystal structures of corundum; chromia addition retards materials' densification of pressureless fired samples but not that of hot-pressed samples. Data from Raman spectroscopy and SEM/EDXS showed the appearance of Ti- and Mn-based impurities near the indentation print, in particular on fractured grains. The addition of chromia improves hardness, but does not affect toughness which is, on the other hand, greatly influenced by materials\u2019 residual porosity

Caratterizzazione microstrutturale ed elettrochimica di rivestimenti per applicazioni in campo energetico

Il miglioramento delle prestazioni dei rivestimenti spessi nel campo energetico è di notevole importanzain quanto le tecnologie attualmente a disposizione sono molto costose e presentano problemi di diversanatura, principalmente nel campo della resistenza alla corrosione. Il materiale di substrato sceltoè un acciaio ASTM 387 grado 22, su cui saranno depositati rivestimenti in Nichel chimico, riporti metallicio cermet depositati con tecnologia HVOF (High Velocity Oxygen Fuel) e rivestimenti ceramici depositaticon tecnica APS (Arc Plasma Spray). I sistemi rivestiti sono composti da: substrato + rivestimento, substrato +interlayer + rivestimento. Alcuni di questi sistemi sono stati sigillati con resina epossidica.Le varie combinazioni di rivestimenti sono state caratterizzate tramite microscopia ottica, misuredi microdurezza e analisi SEM con sonda EDXS, per studiare microstruttura e composizione chimica.Per testare il comportamento a corrosione dei rivestimenti sono state eseguite misure di polarizzazionepotenziodinamica in soluzione simulante un ambiente simile a quello delle centrali geotermiche. I risultatihanno messo in evidenza un effetto barriera, fornito dai rivestimenti studiati in questo lavoro